Provider Demographics
NPI:1710186481
Name:HIALEAH SNF LLC
Entity Type:Organization
Organization Name:HIALEAH SNF LLC
Other - Org Name:PALMETTO REHABILITATION AND HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:TZVI
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGOMILSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-401-7901
Mailing Address - Street 1:1835 NE MIAMI GARDENS DR
Mailing Address - Street 2:#368
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-5035
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6750 W 22ND CT
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-3918
Practice Address - Country:US
Practice Address - Phone:305-512-4688
Practice Address - Fax:305-825-8255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1424096314000000X
332BN1400X, 332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL032416700Medicaid
FL032416700Medicaid